This
year marks the 30th anniversary of the Integrated
Child Development Scheme, or ICDS, which was initiated
in October 1975 in response to the evident problems
of persistent hunger and malnutrition especially among
children.

Since
then, the ICDS has grown to become the world’s largest
early child development programme. The coverage of
the Scheme has expanded rapidly, especially in recent
years. From an initial 33 blocks in 1975, the programme
covered an estimated 6,500 blocks by 2004. There are
almost 600,000 anganwadi workers and an almost equal
number of anganwadi helpers providing services to
beneficiaries throughout the country. According to
the government, the programme currently reaches 33.2
million children and 6.2 million pregnant and lactating
women.

Officially, the objectives of the Scheme are:

to improve the nutritional and health status of
children in the age group 0-6 years

to
lay the foundation for proper psychological, physical
and social development of the child

to
reduce the incidence of mortality, morbidity, malnutrition
and school drop out

to achieve effective coordinated policy and its
implementation amongst the various departments to
promote child development

to
enhance the capability of the mother to look after
the normal health and nutritional needs of the child
through proper nutrition and health education

Accordingly,
the ICDS involves the setting up of anganwadi centres,
each of which is intended to cater to a population
of around 1,000 in rural and urban areas and to around
700 in tribal areas. The anganwadi worker and helper,
who are the basic functionaries of the ICDS, run the
anganwadi centre and implement the Scheme in coordination
with the functionaries of the health, education, rural
development and other departments. They are called
‘social workers’ and are paid an honorarium of Rs.
1,000 per month for the worker and Rs. 500/- for the
helper. However, the supervisors and other higher
officials are government employees.

The anganwadis are meant to provide the following
services:

supplementary
nutrition to children below 6 years of age, and
nursing and pregnant mothers from low income families

nutrition
and health education to all women in the age group
of 15- 45 years

immunisation
of all children less than 6 years of age and immunisation
against tetanus for all the expectant mothers

health
check up, which includes antenatal care of expectant
mothers, postnatal care of nursing mothers, care
of newborn babies and care of all children under
6 years of age

referral
of serious cases of malnutrition or illness to hospitals,
upgraded PHCs/ Community Health Services or district
hospitals

non-formal
preschool education to children of 3-5 years of
age.

By
many accounts, thus far the scheme has been a success.
Most of the studies conducted on the functioning of
the ICDS Scheme have recognised its positive role
in the reduction of infant mortality rate, in improving
immunisation rates, in increasing the school enrolment
and reducing the school drop out rates. The most important
impact of the Scheme is clearly reflected in significant
declines in the levels of severely malnourished and
moderately malnourished children and Infant Mortality
Rate in the country. The percentage of children suffering
from severely malnutrition declined from 15.3 per
cent during 1976-78 to 8.7 per cent during 1988-90.
Infant Mortality Rates declined from 94 per 1000 live
births in 1981 to 73 in 1994.

Nevertheless,
it is also clear that for a scheme that has been in
operation for three decades, the benefits are still
far too limited, and maternal and child health and
nutrition are still areas of major concern for policy.
Even today, around one third of Indian children –
and more than half in rural areas - are born with
low birth weight. Charts 1 and 2 indicate the extent
of severe stunting and severe under-nutrition among
young children in the major states, both of which
are still unacceptably high. It is noteworthy that
these indicators are particularly bad in some ostensibly
more ''developed'' and relatively high-income states,
such as Gujarat, Maharashtra and Karnataka.Chart
1 >>

The high incidence of premature births, low birth
weight and neonatal and infant mortality can be attributed
to poor nutritional conditions of the mothers. The
majority of women still do not get proper nutrition
and health care during their pregnancy. In some areas,
60-75 per cent of pregnant women receive no antenatal
care at all. More than 85 per cent of women in rural
areas and 95 per cent in the remote areas give birth
at home. Only 42 per cent of women in the country
have access to safe delivery facilities.Chart
2 >>

In addition, surveys indicate that even the immunisation
services were still well below minimally acceptable
norms in the 1990s. Chart 3 shows that most children
in the age group 1-2 years were not adequately immunised.Chart
3 >>

What explains this continuing dismal picture even
thirty years after what is one of the more successful
of government schemes was launched specifically to
address these problems? The basic answer must be that
not enough resources have been devoted to this scheme,
to meet the huge requirement. Quite simply, there
are not enough anganwadis or anganwadi workers, and
they do not have adequate resources to meet all the
nutritional requirements of those pregnant and lactating
mother, infants and small children who need them.
If the declared norm of one anganwadi per 1000 population
is to be met, there should be 14 lakh anganwadis,
as against the current 6.5 lakh such centres, of which
only around 6 lakh centres are operational.

There is the further problem of overloading the tasks
assigned to anganwadi workers. The worker and helper
in such centres are paid so little that they are no
more than voluntary workers who receive a paltry ''honorarium'',
and are called ''part-time workers'' in the centres
which are supposed to open for only four hours a day.
Yet they have been found to be among the most dedicated
and committed of public servants who have developed
grassroots contacts and are able to identify particular
individuals and groups in any community easily. They
are therefore increasingly engaged in a wide range
of other public interventions, especially in the rural
areas.

Some of these other jobs in which the anganwadi workers
and helpers are involved relate to Health Department
services such as creating awareness on diarrhoea and
ORS, Upper Respiratory Infections, Directly Observed
Treatment System for Tuberculosis, AIDS awareness,
motivation and education on birth control methods,
etc. There are also additional activities related
to the Education Department like Total Literacy Programmes,
Sarva Shiksha Abhiyan, DPEP, Non Formal Education,
etc.

In some areas, the close relationship that develops
with the local women makes these women insist that
the anganwadi workers accompany them to the hospital
when they go for family planning operations, their
children’s illness, and so on. It is easy to see that
all this amounts to more than a full-time activity,
yet the anganwadi workers and helpers are hardly compensated
for all this. In any case there are simply not enough
of them to cater to all of these varied demands even
within a small population.

There are other problems which stem directly from
this inadequacy of centres, staff and resources to
run this programme effectively. It has been found
that one of the primary reasons for poor coverage
of needy groups under the scheme is the location of
the anganwadi centre, which typically tends to be
in the main village or in upper or dominant caste
hamlets in rural areas in most states. This restricts
the access to such services by deprived communities
such as SCs and STs who live slightly apart. Yet these
are precisely the groups who require it the most.

The expenditure for running the ICDS programme is
currently met from three broad sources:

funds provided by the Centre under ‘general ICDS;
used to meet expenses on account of infrastructure,
salaries and honorarium for ICDS staff, training,
basic medical equipment including medicines, play
school learning kits, etc.

allocations made by the state governments to provide
supplementary nutrition to beneficiaries

funds provided under the Pradhan Mantri Gramodaya
Yojana (PMGY) as additional central assistance,
technically to be used to provide monthly take home
rations to those children (age group 0 to 3 years)
living below the poverty line and in need of additional
supplementary nutrition.

There
are frequent complaints of the delay in central government
transfer of resources for this programme, while state
governments differ substantially in the amount and
quality of supplementary nutrition that is provided.
This makes the Scheme uneven and sometimes even problematic
in terms of the quality of food provided and its acceptability
to small children.

The original intent of the ICDS programme was to address
the various sub-stages (conception- 1 month, <
3 years and 3-6 years) of growth in order to ensure
that negative health and nutritional outcomes do not
accompany the child from one stage to the next. However,
it has been pointed out by many researchers that the
way the programme has been implemented, it effectively
ends up concentrating mainly on the 3-6 years age
group. While children under 3 years are usually enrolled
in the programme, their involvement remains nominal
and there are no facilities to allow for reaching
out to such children and their mothers at home in
an effective way.

The timing of the anganwadi centres also effectively
rules out many of the poorest households, since they
are open only for four hours a day. When both parents
are working, which is typically the case among rural
labour households in many parts of the country, it
is difficult to deliver and pick up the child from
the centre in time, and so children in such households
get excluded from the services. Once again this really
boils down to a question of resources, since these
centres should be open for longer with higher associated
expenditure.

These problems have long been recognised, and public
interest litigation (especially by the People’s Union
for Civil Liberties, among others) has ensured that
some important orders have been passed by the Supreme
Court in this regard. In 2001, the Supreme Court directed
the State Governments and Union Territories to implement
the ICDS in full and to ensure that every ICDS disbursing
centre in the country provide 300 calories and 8-10
grams of protein for each child up to 6 years of age;
500 calories and 20-25 grams of protein for each adolescent
girl; 500 calories & 20-25 grams of protein for
each pregnant woman and each nursing mother; and 600
calories and 16-20 grams of protein for each malnourished
child. The Court also ordered that there should be
a disbursement centre in every settlement.

Despite this court order, the government was slow
to act and very little was done to ensure that these
demands were met even four years later. However, in
the latest Budget Speech of the Finance Minister,
the following promise has been made: ''The universalisation
of the Integrated Child Development Services (ICDS)
scheme is overdue. It is my intention to ensure that,
in every settlement, there is a functional anganwadi
that provides full coverage for all children. As on
date there are 6,49,000 anganwadi centres. I propose
to expand the ICDS scheme and create 1,88,168 additional
centres that are required as per the existing population
norms. Forty seven per cent of children in the age
group 0-3 are reportedly underweight. Supplementary
nutrition is an integral part of the ICDS scheme.
I propose to double the supplementary nutrition norms
and share one-half of the States’ costs for this purpose.
I also propose to increase the allocation for ICDS
from Rs.1,623 crore in BE 2004-05 to Rs.3,142 crore
in BE 2005-06.''

This appears very positive, but it is immediately
evident that this is still well below the requirement
and that even the additional centres will still not
meet the declared population norms. Quite clearly,
the required expansion, in terms of Central allocation
of resources and hiring of more workers, is much greater
than is being envisaged by the Government even now.

More
significantly, the Finance Minister’s statement can
be seen as a partial attempt to meet the increasing
concern of the Supreme Court, which has already twice
reprimanded the government for not doing enough to
ensure the univeralisation and greater effectiveness
of the Scheme. In the latest order, dated 7 October
2004, the Supreme Court issued very detailed and far-reaching
instructions, as follows:

''1. The aspect of sanctioning 14 lakhs AWCs and increase
of norm of rupee one to rupees 2 per child per day
would be considered by this Court after two weeks.
(It was subsequently put off following an affidavit
by the Government.)

2. The efforts shall be made that all SC/ST hamlets/habitations
in the country have Anganwadi Centres as early as
possible.

3. The contractors shall not be used for supply of
nutrition in Anganwadis and preferably ICDS funds
shall be spent by making use of village communities,
self-help groups and Mahila Mandals for buying of
grains and preparation of meals.

4.All State Governments/Union Territories shall put
on their website full data for the ICDS schemes, including
where AWCs are operational, the number of beneficiaries
category-wise, the funds allocated and used and other
related matters.

5.All State Governments/Union Territories shall use
the Pradhanmantri Gramodaya Yojna fund (PMGY) in addition
to the state allocation and not as a substitute for
state funding.

6.As far as possible, the children under PMGY shall
be provided with good food at the Centre itself.

7.All the State Governments/ Un ion Territories shall
allocate funds for ICDS on the basis of norm of one
rupee per child per day, 100 beneficiaries per AWC
and 300 days feeding in a year, i.e., on the same
basis on which the Centre makes the allocation.

8.Below Poverty Line shall not be used as an eligibility
criterion for ICDS.

9.All sanctioned projects shall be operationalised
and provided food as per these norms and wherever
utensils have not been provided, the same shall be
provided. The vacancies for the operational ICDS shall
be filled forthwith.

10. All the State Governments/Union Territories shall
utilise the entire State and Central allocation under
ICDS/PMGY and under no Circumstances, the same shall
be diverted and preferably also not returned to the
Centre and, if returned, a detailed explanation for
non-utilisation shall be filled in the Court.

11.All State/Union Territories shall make earnest
efforts to cover the slums under ICDS.

12.The Central Government and the State/Union Territories
shall ensure that all amounts allocated are sanctioned
in time so that there is no disruption whatsoever
in the feeding of Children.''

These are extremely important guidelines, yet it is
evident that the government is not likely to conform
to them without sufficient social and political pressure.
It is a sad commentary on the state of public intervention,
that even the most critical schemes that are universally
acknowledged to be necessary to ensure the future
of the country, must be fought for in courts of law
and then insisted upon through activism and people’s
struggles.